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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2012 January;78(1):94-104


language: English

Continuous infusion vs. bolus dosing: implications for beta-lactam antibiotics

Mohd Hafiz A. A. 1, Staatz C. E. 2, Kirkpatrick C. M. 3, Lipman J. 4, 5, Roberts J. A. 4-6

1 School of Pharmacy, International Islamic University of Malaysia, Kuantan, Malaysia; 2 School of Pharmacy, University of Queensland, Brisbane, Australia; 3 Faculty for Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; 4 Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia; 5 Department of Intensive Care, Royal Brisbane and Women’s Hospital, Brisbane, Australia; 6 Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia


Beta-lactam antibiotics display time-dependant pharmacodynamics whereby constant antibiotic concentrations rather than high peak concentrations are most likely to result in effective treatment of infections caused by susceptible bacteria. Continuous administration has been suggested as an alternative strategy, to conventional intermittent dosing, to optimise beta-lactam pharmacokinetic/pharmacodynamic (PK/PD) properties. With the availability of emerging data, we elected to systematically investigate the published literature describing the comparative PK/PD and clinical outcomes of beta-lactam antibiotics administered by continuous or intermittent infusion. We found that the studies have been performed in various patient populations including critically ill, cancer and cystic fibrosis patients. Available in vitro PK/PD data conclusively support the administration of beta-lactams via continuous infusion for maximizing bacterial killing from consistent attainment of pharmacodynamic end-points. In addition, clinical outcome data supports equivalence, even with the use of a lower dose by continuous infusion. However, the present clinical data is limited with small sample sizes common with insufficient power to detect advantages in favour of either dosing strategy. With abundant positive pre-clinical data as well as document in vivo PK/PD advantages, large multi-centre trials are needed to describe whether continuous administration of beta-lactams is truly more effective than intermittent dosing.

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